Movement Disorders Flashcards
What is a Movement disorder?
impairs the regulation of voluntary motor activity without directly affecting strength, sensation or cerebellar function
what is the major Hypokinetic Movement Disorder?
Parkinson’s Disease (major disorder)
what are examples of Hyperkinetic Movement Disorders?
Huntington’s Disease
Wilson’s Disease
Tourette’s Syndrome
Restless Leg Syndrome
what is parkinsons disease?
synydrome with combo of tremor, rigidity, bradykinesia, and characteristic disturbance of gait and posture
what is the average onset of parkinsons?
mid-late life; mean age is 57 yrs
who does parkinsons affect?
Affects all ethnicities
has equal M/F distribution
occurs 1 per 100 people that are over 65 yrs
4th most common disease in the elderly
what are symptoms of parkinsons caused by?
Decreased movment due to lack of DA in substantia nigra projecting to striatum
what is the pathophysiology of parkinsons?
- Loss of dopaminergic cells in substantia nigra
- Poor regulation of Striatum output
- Decrease in thalamic excitation of motor cortex
- Decreased excitation of corticospinal tracts.
what are the 4 hallmark signs of parkinsons?
Resting Tremor (aka Pill-Rolling)
Rigidity (Lead-Pipe or Cogwheel)
Bradykinesia: slow starting/initiate movement
Festinating: Flexed Posture with shuffling gait
how can you look for differential diagnosis?
must look for tremor disease that arent parkinson’s
Involuntary tremor vs. Intentional tremor
Depression
Wilson’s Disease
Huntington’s Disease
what is huntingtons disease?
genetic neurodegenerative disorder which predominately has behavioral, cognitive, or movement disorders signs
what is the 1st sign of huntingtons disease?
change in personality (impulsive, irritable, irrational)
who does huntingtons disease affect?
50% chance to pass on the disorder
Paternal Descent
30-40 y/o diagnosis
what is the pathophysiology of huntingtons disease?
Mutation on chromosome 4 increasing glutamine production
Over-expression of gene: i.e. excess glutamine, excitotoxicity
Atrophy & neuronal degeneration of cortex causing uncontrolled movements, loss of intellect, and emotional disturbance*
what is a hallmark of huntingtons disease?
caudate atrophy
what type of physical findings are there for adult onset of huntingtons?
Prominent chorea
Bradykinesia
Postural reflex compromise
what are the physical findings for terminal huntingtons pts?
Lack of motor coordination of mouthc. Dysarthria, dysphagia, & respiratory difficulties
what are general mental findings of huntingtons?
Cognitive impairment
Depression
Psychiatric disorders
what causes wilsons disease?
Autosomal recessive trait
excessive copper that somenoes body cant break down
what is the pathophysiology of wilsons disease?
Abnormal copper metabolism
Deposition of copper in tissues
Txable and reversible and repressive
what are signs and symptoms of wilsons disease?
Tremors Dystonia gait: loose Depression Difficulty speaking, swallowing Easy bruising Fatigue Joint pain Loss of appetite, Nausea Skin rash Swelling of arms and legs jaundice
what is Tourette Syndrome?
Dxed when childhood onset tics are multifocal (many tics), motor or vocal, lasting longer than 1 yr and naturally wax and wane
what part of the brain is involved in tourette syndrome?
caudate Nuc
Excessive projections to caudate
Studies show caudate atrophy, enlarged lateral ventricles
what is the incidence of tourette syndrome?
Onset: 2-21 y/o
Male predilection
what are simple tics?
Motor: blinking, facial grimacing, shoulder shrugging
Vocal: throat clearing, grunting, snorting, barking
what are complex tics?
Motor: hopping, skipping, Echopraxia
Vocal: Coprolalia, Echolalia, Palilalia
what is Echopraxia?
mimicking of movements
what is Coprolalia?
explosive utterance of foul words
what is Echolalia?
mimicking of someone elses words
what is Palilalia?
repetition of syllables, words, or phrases of one own’s words
what is restless leg syndrome diagnostic criteria?
Desire to move limbs which is associated with unpleasant sensations
Restlessness
Worsening of symptoms @ rest w/ temporary relief w/ movement
Worsening of symptoms @ night
what are common sxs of of restless leg syndrome?
Need to move Crawling Tingling Itching Restless
what is Sydenham’s chorea?
Excessive movement
Mainly children / adolescents
Complication of previous group A streptococcal infection
remits spontaneously
what is myoclonus?
sudden, brief, shock-like involuntary movements
what is positive vs negative myoclonus?
positive: caused by active muscle contraction
negative: caused by inhibition of ongoing muscle activity
what is generalized vs focal myoclonus?
Generalised - widespread throughout body
Focal / segmental – restricted to particular part of body
what is ballismus?
Violent “flinging” movement of entire limb
Almost always unilateral
Involves proximal musculature
how does ballismus occur?
Usually due to a CVA in contralateral subthalamic nucleus
what is chorea?
Rapid irregular muscle jerks
May affect limbs, head, face and tongue
usually distal movements (proximal movements called ballismus)
how does chorea present itself?
Pts attempt to conceal involuntary movements by superimposing voluntary movements onto them
what is Athetosis ?
Slow, flowing, often twisting movements
Occurs mainly distally (hands, fingers)
Can also affect face and tongue
what is choreoathetosis?
combo of involuntary movement
overlap between syndromes
what is dystonia?
patient assumes a sustained, abnormal posture or limb position Due to co-contraction of agonist and antagonist muscles
